MANAGING PEOPLE IN NETWORKED … PEOPLE IN NETWORKED ORGANISATIONS: IDENTIFYING THE CHALLENGES FOR HEALTHCARE AND SOCIAL CARE Professor Damian Grimshaw and Professor Jill Rubery European

MANAGING PEOPLE IN NETWORKED ORGANISATIONS: IDENTIFYING THE CHALLENGES FOR HEALTHCARE AND SOCIAL CARE

Professor Damian Grimshaw and Professor Jill Rubery

European Work and Employment Research Centre (EWERC), Manchester Business School, The University of Manchester 31.03.11

Managing people in networked organisations: Identifying the challenges for healthcare and social care

© CfWI | Month Year 2

DRAFT # CONFIDENTIAL – footer

TABLE OF CONTENTS

Table of contents ................................................................................................. 2

Executive summary .............................................................................................. 3

Workforce Risks and Opportunities: Briefing Papers ............................................ 4

Introduction .......................................................................................................... 5

1 Making a market – but what type of contracting? ........................................ 7

2 Bringing the employer back in: An overview of the issues ........................... 9

3 Case studies of networks in healthcare and social care ............................ 13

3.1 Case study 1: Network care ................................................................. 13

3.2 Case study 2: Hospital services ........................................................... 14

4 What lessons for HRM from research on inter-organisational networks?... 17

4.1 General lessons ................................................................................... 17

4.2 Lessons for areas of HRM ................................................................... 17

5 References ............................................................................................... 19

Tables and Figures

Figure 1. Managing HRM in networked organisations ........................................ 9

Box 1. Employment regulation for staff transfer: Ending the Two-Tier Code ....... 10

Table 1. Trust and power in network forms of organisation……………………..…8

Table 2. New challenges for HRM in networked organisations ........................... 11




EXECUTIVE SUMMARY

At a time government policy is to promote a step-change expansion in the

involvement of multiple providers of healthcare and social care, it is essential that

we learn the lessons from existing research on the challenges of managing

employment within networks of organisations. Networks involve multiple

organisations that collaborate through contracts and agreements to deliver

services jointly. This report summarises the key issues for managing people in

networks with the goal of setting out clear lessons for practitioners and policy-

makers.

Appropriate management of employment is central to the delivery of services in

any model of organisational structure. Network structures pose particular

challenges that need to be recognised. These arise first from the need to

establish trusting, collaborative relationships among partner organisations. Where

organisations have different priorities and policy objectives such relationships

may be difficult to forge. Second, within a network, it may be unclear which

employer has responsibility for managing employment and staff development,

including opportunities for skill development and career planning and

progression. No single employer may be able or willing to take full responsibility

and employees face inconsistency and uncertainty in the rules governing their

employment. The report concludes by identifying key lessons for those with

responsibilities for policy-making and management practice. These include

general lessons about the design and management of networks and specific

lessons for areas of human resource management.




WORKFORCE RISKS AND OPPORTUNITIES: BRIEFING PAPERS

The Centre for Workforce Intelligence Workforce Risks and Opportunities project

sets out the major risk and opportunities facing the health and social care

workforce in 2011 and beyond. The University of Manchester is providing

specialist knowledge to CfWI through an integrated approach across a range of

disciplines. This is one of a series of briefing papers to provide managers and

workforce planners with evidence to inform their choices when addressing short,

medium and long-term workforce challenges. This particular paper was first

presented and discussed at a CfWI conference in October 2010, ‘Any willing

provider: challenge or opportunity for workforce planning’.

The 2011 series of briefing papers focuses on:

General principles of labour substitution

Economic influences on the labour market

Working time practices

Skill mix in Dentistry

Skill mix changes in Pharmacy

Workload safety in Pharmacy

Managing people across health and social care networks




INTRODUCTION Andrew Lansley’s proposed reform of the way healthcare is delivered in the NHS

promises to make a new market for the bidding and delivery of services,

introducing lots more competition among a diverse range of healthcare suppliers

– ‘any willing provider’, to use the much quoted phrase from the government’s

White Paper.1 The proposals set out a new regulatory framework for the

commissioning and delivery of services, including extended powers to the

regulatory body, Monitor, to ensure the rules of market competition are applied in

the bidding for contracts.

There are many risks and potential dangers of this proposed reform, not least for

the NHS itself. NHS trusts face the potential loss of the more routine and

potentially profitable areas of healthcare services that have traditionally helped to

subsidise the more complex and resource-intensive services. Large multinational

companies will enter the market and may seek to gain market share by bidding at

low prices in order to gain a competitive foothold in the fast-expanding market.

NHS trusts will find themselves operating at a disadvantage in this new more

open market. It is these kinds of concerns that led the editors of the Lancet to

warn, ‘As it stands, the UK government’s new bill spells the end of the NHS’.2

The ‘any willing provider’ reforms present another set of risks that are less widely

commented upon. These concern the difficulties of managing employment under

network arranagements. The future scenario involves a diverse network of

organisations, each contracted to deliver high quality services that crucially

depend upon a highly qualified and committed workforce. But what are

government expectations about how these networks of organisations share

responsibilities for training and skill development, career planning and job

mobility?

The NHS has a strong tradition in crafting high quality policies and practices for

people management. However, there is a high risk that many of the positive

developments in recent years (especially around skill development and pay

policy) will not be built upon. It is not at all clear, for example, whether or not the

government intends services contracts to include clauses that require provider

organisations to sign up to certain principles of workforce planning. And there are

many other scenarios that raise challenges for people management. What

happens when teams of employees work together from different organisations –

should there be a consistent approach to managing these networks of teams?

When organisations work together to provide joined-up services, how do they

agree to share the risks and costs of training provision? If the services contract is

short-term will the organisation have sufficient incentive to invest in skills?




Indeed, to counter the increased high risk of fragmentation and instability of

employment, would it not be sensible to develop a wider regulatory framework for

human resource management (covering skill accreditation, pay and benefits, for

example) and extend it across the sector, covering all organisations?

These are some of the questions that are addressed in this report. Our method of

argument involves reviewing a range of high quality empirical evidence on

network forms of public services delivery and their implications for people

management. Much of this research was undertaken by teams of experts at the

Manchester Business School. Full references to the books, research reports and

journal papers are provided where appropriate. The objective of the report is

therefore to distil the relevant lessons from already tested models of public

services networks for current policy debates about reforms of healthcare and

social care. It draws especially on detailed evidence of a partnership to deliver

integrated care services between local authorities and the NHS and a public-

private partnership centred on a PFI agreement between an NHS trust and a

private sector consortium.

Four key observations constitute the threads of our argument:

i) the resources committed to commissioning and the balance of

expertise among partner organisations are critical factors in efforts to

establish trusting, collaborative networks;

ii) the development of shared values among partner organisations,

especially with respect to the nature of the public services, underpins

the effective coordination of an approach to people management;

iii) the nature and quality of work organisation is central to the success of

any collaborative network structure; and

iv) jointly negotiated regulations between employers and trade unions

provide a desirable consensus-approach to the coordination of human

resource policies and practices

The report is organised as follows. Section 1 argues that all too often policy-

makers’ vision of market competition is highly abstract and not realistic. Real

world markets involve complicated forms of contractual relations, differences in

trusting relations between partners, and exploitation of power relations. Each of

these factors upset the claims made by policy-makers that increased market

competition generates enhanced performance and innovation. Section 2 argues

for the need to focus on the crucial issue of the employment relationship. Even

networks with strong trust between organisations face difficulties in delivering

‘best practice’ collaborative working because of limits to integrating diverse

approaches to HRM approaches among network partner organisations. Section 3

presents two illustrations of network forms – one public-public and one public-

private. Section 4 concludes with a summary of lessons for HRM in healthcare

and social care networks.




1 MAKING A MARKET – BUT WHAT TYPE OF CONTRACTING?

At the heart of the government’s vision for the NHS, as set out in its 2010 White Paper and the 2011 Health and Social Care Bill, is the notion that healthcare and social care services would be delivered more effectively by extending the variety of provider organisations. In line with the wider government position that the state ought not to exercise a monopoly over public services (BBC news 21/02/113), reforms are likely to allow for the establishment of new GP consortia that will commission services from ‘any willing provider’, whether public or private sector, voluntary, charity or social enterprise organisation.

In part, we are witnessing the evolution of already existing practices. The observation in the White Paper that the NHS ‘works better across boundaries, including with local authorities and between hospitals and practices’ (p9) picks up on reforms initiated by New Labour that sought to establish a collaborative approach among organisations in many areas of public services delivery. The core principles were set out in the 1999 White Paper, ‘Modernising Government’. Public-private partnerships were encouraged, ranging from Independent Sector Treatment Centres to the hundreds of Private Finance Initiatives. So too were public-public partnerships, with the aim of ‘joined-up’ services delivery - for example by integrating local authority and NHS provision of health and social care.4

However, it was under previous Conservative governments that the real foundations were laid for the making of markets for public services. The 1989 White Paper, ‘Caring for People’, required local authorities to promote and develop a ‘flourishing independent sector’ for elderly care. Also, reforms through the 1980s and 1990s promoted compulsory competitive tendering of public services. The principle of increasing choice by extending the market therefore reflects a continuation of policy direction marked out since the early 1980s, albeit marking a radical change of pace.

These new reforms are nevertheless in danger of failing to learn from mistakes already made. One fundamental lesson is that the making of markets does not involve the simple shift from a bureaucratic form of organisation to a competitive form of market organisation. There is no international evidence of competitive markets (as defined in economics textbooks) for public services as far as we are aware. Instead, when markets for public services are established we typically observe the development of hybrid forms, or network models, of services delivery. In these network models, we are more likely to find that large bureaucratic organisations, whether public sector organisations or large private sector multinationals, are able to flourish than small competitive private or voluntary sector enterprises.. Also, because of their importance to the overall well-being of a society, there is often a great deal of expenditure on the regulation of services quality. This considerably complicates the functioning of a




competitive market since it means that price can not be the over-riding mechanism for allocating contracts.

The research evidence on network forms of organisation highlights two important variables. The first is trust. Strong trust between organisations can reduce the risk that one partner acts opportunistically to the disadvantage of another. The second is power. Where differences between organisations in their financial resources and expertise are small, there is greater chance for sustaining a coordinated approach to delivery of networked services.5 Table 1 sets out the key issues.

Table 1. Trust and power in network forms of organisation6

TRUST

Strong

Strong trust supports those partners that seek to bring potentially complementary areas of specialist expertise to co-produced public services

Weak

Weak trust can foster an overly formalised approach to contract performance discipline. This requires a high commitment of time and resources and reduces efficiencies

POWER

Equal

Equal power relations often require external support either from other divisions in the organisation or from regulatory bodies. Both forms of support serve to balance unequal power relations and enhance prospects for sustainability

Unequal

Unequal power relations take different forms. Weak public sector expertise in contract design undermines performance gains from network forms. Weak private sector HRM expertise can make it difficult to sustain cooperative employment relations. Too much power exercised by a public sector purchaser can undermine efforts by providers to improve conditions.

What are the lessons for current policy proposals? The expanded role of the regulatory body, Monitor, is intended to enable it to promote competitive markets and where necessary to set ‘efficient prices’.7 However, it is not clear what resources or institutions are envisaged to create and sustain what we might refer to as ‘the right kinds of contracting forms’, which sit at the heart of the new market for healthcare and social care services. Questions for the policy and practitioner audience include:

What types of collaborations among organisations are anticipated?

Are partner organisations expected to establish strong trusting relations, or will arms-length relations be as effective?

What measures are in place to prevent exploitative power relations between partners - that is, to prevent unfair displacement of risk and financial gains?




2 BRINGING THE EMPLOYER BACK IN: AN OVERVIEW OF THE ISSUES

There is by now a great deal of empirical evidence that employment issues are at the centre of efforts to establish and sustain networks of organisations.8 The challenges for HRM in a networked organisation are quite different to those in a single organisation where the employment relationship – defined as the contract between an employer and one or more employees – is widely understood. In networked organisations, many new issues arise. Workers may spend most of their working days not at the workplace of their legal employer but at that of a client or partner organisation. Lines of authority and accountability become disordered as workers have to balance the requirements of managers in client organisations with line managers in their employing organisation. Commercial contracts governing the collaboration between client and provider organisations complicate HR practices and in some situations the wishes of clients can influence the provider’s approach to staffing, pay and skill development.

Figure 1 illustrates the cross-cutting lines of collaboration and coordination among both managers and workers from two networked organisations, A and B. Our argument here is that whatever forms of trust and power prevail among networked organisations, each organisation faces considerable challenges in resolving differences of approach towards HRM.

Figure 1. Managing HRM in networked organisations9

Organization B

Managers

Workers

Organization A

Managers

Workers




All the different areas of HRM face challenges. Table 2 provides a summary of issues for three selected areas. Recruitment and selection can often benefit from tighter network relationships, providing an accessible pool of potentially valuable skills and capabilities from partner organisations. Also, new contracts to deliver outsourced services are often accompanied by transfers of experienced staff with the expertise to ensure a seamless transition of services as a new provider takes over the contract.

However, staff transfer is a constraint on workers’ freedom to choose their employer; it typically increases job insecurity and it may not match workers’ expectations about pay and career advancement. As such it carries a high industrial relations risk. For this reason, most governments have developed an appropriate framework of employment regulation to maximise the benefits from staff transfer (although see box 1). In addition, better outcomes are associated with investment by client and supplier organisations in extensive joint preparations and comprehensive engagement with relevant trade unions and professional bodies.

Table 2. New challenges for HRM in networked organisations10

Recruitment - External links with other organisations provide a new pool of possible recruits

- Client organisations can influence selection and transfer

- Limited freedom of choice for transferring workers strengthens industrial relations effects

- Employment protection legislation creates strong legacy effects

Skill development - Contract performance monitoring encourages simplification of tasks and use of casual employment contracts

- Finite contract duration destabilises training investment

- New career opportunities - Externalising knowledge introduces risks for client

Job security - Risk of job loss pre- and post-transfer (subject to legal protection)

- Job security contingent upon contract security

Skill development and training provision is a second area of HRM that deserves

reappraisal in networked organisations. On the upside, networks provide

opportunities for new knowledge flows as workers develop expertise and careers

across organisational boundaries.11 However, too much knowledge ‘leakage’ may

disadvantage one of the partner organisations.12




Also, job design may be constrained by the need to specify a narrow bundle of

job tasks to meet contractual requirements13. Contracts based on strict

performance evaluation may inhibit innovation in the design of jobs to allow

workers’ to develop their skills and knowledge and to have the discretion to build

on their knowledge to improve services. The fact that contracts may only last a

short period can fuel uncertainty over decisions to fund training programmes for

particular skill-sets.14 This is further complicated by the difficulty of establishing a

shared vision among organisations about the quality of skill standards required

both in the provision of services to a client and among employees who work in

joint teams.15

Box 1. Why abolishing the Two-Tier Code is bad news for managing staff transfer

The Two-Tier Code was introduced following a long-running trade union campaign to protect low-paid workers employed on outsourced government contracts (typically cleaning hospitals and council buildings, or providing catering services or social care services). The aim of the Code introduced by the Labour government in 2003 was to prevent the development of two tiers of employment conditions among workers at the private firms providing outsourced public services. It required employers to provide new recruits with broadly similar employment conditions to those for workers transferred from the public sector whose terms and conditions are protected under the TUPE (Transfer of Undertakings Protection of Employment) transfer regulations.

The code provided valuable protection for low-wage workers. Moreover, EWERC research suggests the principle enshrined in the code of providing ‘employment on fair and reasonable terms and conditions … no less favourable than those of transferred employees’ was widely accepted by all the main organisations - including the NHS Employers’ Federation and the private sector providers.

But the Code as applied to healthcare services was abolished in December 2010 with very little justification or explanation. Francis Maude, on behalf of the Cabinet Office, stated, ‘The code did little to protect staff, while deterring responsible employers from delivering public service contracts. ... We should not be making it more difficult for small businesses and voluntary organisations to succeed in the public service market.’ This conflicts with the OECD’s evaluation of the Two-Tier code in 2008, which states that the UK was a positive example for other countries of regulations that ‘ensure fair job transitions for public employees affected by public private partnerships’ (2008: 121).

Job security is a third area of HRM that requires renewed scrutiny in a network

context. Network forms in principle shift worker expectations away from a

continuous open-ended employment contract with a single organisation to a new

norm of multiple transitions between employers. In particular, the notion of job




security becomes associated with the nature and duration of the contract for

services.

Policies of outsourcing and marketisation of public services are well known for

their job loss effects.16 However, much depends on the regulatory policies, as

well as organisations’ preference for redeployment to reduce the potential loss of

knowledge. Past regulations to extend public sector standards to private

contractors with the Two-Tier Code offered one possible mechanism to counter

the destabilising effects of marketisation.17




3 CASE STUDIES OF NETWORKS IN HEALTHCARE AND SOCIAL CARE

Detailed case studies of already existing networks in healthcare and social care

offer a valuable guide to thinking through the issues confronting the approach to

people management. A range of opportunities and challenges are identified in

research. Here we report two case studies of networks undertaken by the

EWERC team - a public-public collaborative partnership, referred to as ‘Network

Care’, and a public-private partnership, ‘Hospital Services.18.

Both cases display strong trusting relations and evidence of mutual collaboration.

Each summary portrait focuses on three issues for HRM - worker commitment,

skill development and career pathways. We draw general lessons for HRM in

networks in the following section.

3.1 Case study 1: Network care

Description

Set up in 2002, Network Care provides integrated care services between the

NHS and local authorities. It pools budgets, has a joint leadership team, joint

commissioning and joint services (including a joint HR department). It also

subcontracts most of its domiciliary care work to a wide range of contractors with

whom it has rather distant or low trust relations. The case study focuses on the

health and social care (HSC) partnership between the primary care trust and the

local authority for adult services. Central to the partnership is the deployment of

integrated HSC teams involving staff working for different employers.

Worker commitment

Key factors that underpinned a joined-up approach to fostering a unified sense of

worker identity and commitment were a) a trusting relationship between senior

managers, b) a strong commitment of both organisations to the partnership and a

shared vision of meeting patient interests, and c) a unified staff communications

strategy, involving monthly team briefs and a joint newsletter.

But other factors meant both partners also had to agree a strategy that to some

extent acted to preserve separate identities. The decision to establish integrated

teams of HSC workers faced initial setbacks because workers still wished to

retain a strong sense of professional identity, which was perceived to be allied

with the employing organisation. Therefore, managers jointly agreed to allow

workers selected for integrated teams to choose which organisation would

employ them – the PCT or the local authority.

Skill development




The partnership offered new opportunities for training and skill development.

Importantly, new opportunities were supported by both partners sharing access to

management training; for example, local authority managers attended PCT

leadership development courses. The partnership also set up a new integrated

training programme with a team of 21 staff providing NVQ certified skills.

Professional and organisational identities can be considerd to act as key

constraints on the realisation of a shared vision.. Managers recognised that the

employing organisation, not the partnership, ought to take the lead in identifying

and delivering targeted professional development. As one PCT manager put it:

‘So if you’ve got a health worker working in the youth offending team, it would be

the PCT’s responsibility to make sure those workers were developed in

accordance with [new policy developments].

Career pathways

Again, managers perceived the partnership could offer many interesting and

positive opportunities. The vision for the integrated team involved what managers

referred to as new ‘generic’ and ‘hybrid’ posts – front-line and managerial – that

cut across traditional organisational and professional boundaries between health

and social care.

However, both sides of the HSC partnership represent very small divisions of

much larger organisations and both the NHS and local authorities were

witnessing distinctive reforms of HR agendas that shaped the wider context of

careers. The NHS ‘skills escalator’ policy, for example, was perceived as

outpacing HR practice in local authorities an this was to some extent undermining

faith in what could be achieved through integration.

3.2 Case study 2: Hospital services

Description

This public-private partnership is a £500-million PFI agreement that involves the

commissioning by an Acute Trust for a private sector consortium to finance and

construct new hospital buildings and to provide estate and ancillary services.

Central to the partnership is a complex transfer of staff from the Trust to the

private services firm, FacilitiesCo. A first stage saw the transfer of 70 estates

staff. Stage two involved 900 ‘soft’ facilities staff (cleaners, porters, caterers,

laundry, switchboard workers) – supervisory staff transferred and non-

supervisory staff were retained as NHS employees under a new ‘Retention of

Employment’ agreement.

Worker commitment

Managers sought to build trust by establishing regular ‘mobilisation meetings’

while phasing in the new arrangements. There was a culture of sharing




information between the Trust and FacilitiesCo. Critically, trade union

representatives were involved, including through participation in the mobilisation

meetings and in designing the eventual ‘retention of employment’ model of staff

transfer. This alternative staff transfer model underpinned industrial relations

peace and continued staff commitment.

But other factors conspired against a new partnership-oriented workforce

commitment, in particular a deep-seated clash of approaches to managing staff.

One FacilitiesCo manager argued ‘we are much more effective at managing

these people’ in defence of its practice of applying pre-existing NHS disciplinary

procedures more rigorously. But NHS managers were sceptical and argued there

was a pressing need to understand how to manage workers who still desired to

be part of ‘the NHS family’ and who were uncomfortable about delivering a profit.

Skill development

FacilitiesCo was expected to provide many new opportunities. As one HR

manager put it, ‘They’ve got the money for the best equipment, the money for the

best training of staff’. Also, unions welcomed several areas of new job design

following past under-investment by the Acute Trust; one example involved multi-

tasking for porters, including distributing cleaning materials and catering trolleys.

There was some evidence of a shared approach to training. Newly transferred

managers and supervisors attended Acute Trust programmes on recruitment and

skill development, as well as FacilitiesCo sessions on good HR practice and

commercial awareness.

One weakness, however, was that the shared approach only applied to

FacilitiesCo staff. NHS managers charged with monitoring and evaluating the

services contract were excluded from FacilitiesCo training, including the

commercial training which was seen to provide their counterparts a critical

advantage in managing the contract.

Career pathways

New career pathways were anticipated with the possibility of supervisory staff

enjoying many other opportunities in the global facilities company. But the model

of staff transfer presented a major complication. For non-supervisory staff, the

‘retention of employment’ model meant that promotion to supervisor required a

change of employer from Acute Trust to FacilitiesCo. Not only would this create

uncertainty but staff would lose their NHS pension.

FacilitiesCo managers recognised that the improved pay and status with

promotion would not necessarily provide sufficient incentive:

If you’ve got a cleaner who is at the top of Band 2, the team leader is only the

next band up. I mean there is then the potential to go quite a lot higher but we are

not giving them a lot of money to start with. And they have to accept … that we




can’t do anything about the fact that at that point they are going to leave the NHS

pension scheme.




4 WHAT LESSONS FOR HRM FROM RESEARCH ON NETWORKED ORGANISATIONS?

It is already the case that many employment relationships in healthcare and

social care go beyond a simple definition of a single employer and its employees.

If the proposed reforms go through, then employment will be increasingly

organised across networks of employing organisations. A growing body of

research, including that undertaken within EWERC, suggests several areas

where lessons need to be learned. We conclude this brief report by presenting

the general lessons for the design and management of networks, as well as the

particular lessons for key areas of HRM.

4.1 General lessons:

Carefully designed government regulations are required in the formation and

sustaining of new markets for healthcare and social care. Many standards

require regulation, including codes of practice, contractual agreements and

government targets. Whatever the form of regulation, the evidence suggests it

ought to involve and be responsive to a wide-ranging community of interests.

This includes patient/user advocates, trade unions and NHS authorities,

among others.

Because networks inject turbulence into the employment relationship, trade

unions are an essential partner in their design and development. Workplace

agreements, typically within a national framework of coordinated union

activities, have supported positive initiatives including the innovative ‘retention

of employment’ model of staff transfer.

Trust and a willingness among managers from the networked organisations to

work closely together would appear to be an essential prerequisite for effective

networks. Continuity of approach is vital and can be easily lost where there is

high turnover of managers or insufficient investment in the time and resources

required to support the partnership.

4.2 Lessons for areas of HRM:

The development and sustaining of networks requires the sharing of ideas and

development of communications and engagement agendas to support worker

commitment. In view of their strong presence in the public sector, effective




partnering with trade unions can be vital both to help develop worker identities

and to promote alignment of individual goals with network objectives.

A networked approach to skill development offers the potential for many new

positive opportunities but can easily be hampered by three factors. First,

organisations may have unresolved differences in performance goals such

that different types of skills are promoted and valued. Second, many

employees may spend most of their time away from the workplace of their

employing organisation and therefore remain ‘invisible’ to managers seeking

to identify their skill needs. Third, collaborative networks may require a shared

approach to training provision in order to maximise, and benefit from, the

networking of knowledge flows.

HR managers face several obstacles to the effective planning of career

pathways. New integrated career paths among teams from different partner

organisations are difficult to organise, especially where new career paths

conflict with conventional professional promotion routes. Also, where

promotion pathways require mobility from one organisation to another, then

individuals may face obstacles where there are no incentives that facilitate

such moves.




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6 ENDNOTES

1. Department of Health (2010).

2. The Lancet, Vol. 377, Issue 9763, page 353 (January 2011).

3. http://www.bbc.co.uk/news/uk-politics-12520491.

4. For a more detailed discussion see Pollock and Kirkwood (2009) on public-

private partnerships and Glendinning et al (2002) on public-public

partnerships.

5. See Dore (1996), Powell (1990) and Sturgeon (2002).

6. Summary of findings from Grimshaw et al. (2002), Grimshaw and Hebson

(2005).

7. Monitor will be expected to ensure the development of a market of

providers. This includes investigating complaints of anti-competitive

behaviour where a GP consortia fails to tender services or discriminates in

favour of incumbent public sector providers (Department of Health 2010,

page 39).

8. See, for example, Grimshaw and Miozzo (2009), Marchington et al. (2005,

2009), Rubery et al. (2003), Swart and Kinnie (2003).

9. Adapted from Grimshaw et al. (2005: figure 1.2).

10. Adapted from Grimshaw and Miozzo (2009: table 1).

11. Lam (2007)

12. Swart (2007)

13. Grugulis et al. (2005).

14. Grimshaw and Miozzo (2009: 1541)

15. See Marchington et al. (2009: 43-45)

16. Colling (1993), Escott and Whitfield (1995)

17. Bach and Givan (2010)

18. The results of both cases are reported in greater detail in other publications

– Grimshaw et al. (2010), Marchington et al. (2009, 2011) and Rubery et al.

(2009).

http://www.bbc.co.uk/news/uk-politics-12520491




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